title: Factors attributing to the failure of endometrial sampling in women with postmenopausal bleeding.
abstract: OBJECTIVE
  To determine which doctor- and patient-related factors affect failure of outpatient endometrial sampling in women with postmenopausal bleeding, and to develop a multivariable prediction model to select women with a high probability of failed sampling.
  
  
  METHODS
  Prospective multicenter cohort study.
  
  
  METHODS
  Three teaching hospitals in the Netherlands.
  
  
  METHODS
  Women presenting with postmenopausal bleeding with an indication for endometrial sampling.
  
  
  METHODS
  Multivariable logistic regression was performed to evaluate the impact of doctor's training level and patient's characteristics on failure of sampling.
  
  
  METHODS
  Failure of endometrial sampling, classified as technical failure or insufficient tissue for diagnosis.
  
  
  RESULTS
  In 74 (20.8%) of the 356 included women, sampling technically failed, and in 84 (29.8%) the amount of tissue was insufficient for diagnosis. Nulliparity [odds ratio (OR) 3.8, 95% confidence interval (CI) 1.8-7.9] and advanced age (OR 1.03 per year, 95% CI 1.00-1.06) were associated with technical failure. Advanced age was associated with insufficient sampling (OR 1.04 per year, 95% CI 1.01-1.07), and endometrial thickness >12 mm decreased the chance of insufficient sampling (OR 0.3, 95%CI 0.1-0.8). The prediction model for total failure had an area under the ROC curve of 0.64 (95% CI 0.58-0.70).
  
  
  CONCLUSIONS
  In women with postmenopausal bleeding, the failure rate of endometrial sampling is relatively high and is associated with nulliparity and advanced age. Endometrial thickness >12 mm decreased the chance of failure. A multivariable prediction model for total failure based on patient characteristics has a moderate capacity to discriminate between women at high or low risk of failure.
authors.affiliation: Department of Obstetrics and Gynecology, TweeSteden Hospital, Tilburg, the Netherlands.
authors.forename: Nicole C M
authors.initials: NC
authors.lastname: Visser
authors.forename: Maria C
authors.initials: MC
authors.lastname: Breijer
authors.forename: Malou C
authors.initials: MC
authors.lastname: Herman
authors.forename: Ruud L M
authors.initials: RL
authors.lastname: Bekkers
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Veersema
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.forename: Anne
authors.initials: A
authors.lastname: Timmermans
authors.forename: Johanna M A
authors.initials: JM
authors.lastname: Pijnenborg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001706:Biopsy; D003661:Decision Support Techniques; D016889:Endometrial Neoplasms / Q000150:complications / Q000473:pathology*; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017698:Postmenopause; D011446:Prospective Studies; D012372:ROC Curve; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000473:pathology
keywords: Endometrial sampling; non-diagnostic sample; postmenopausal bleeding; prediction model; risk factors